How can you tell if someone is a non responder?
Dr. Rustin Berlow discusses best practices for deciding whether or not a patient is a good responder to TMS treatment.
Does everybody respond to TMS?
Have you made a decision as to when someone is a non-responder? Or do you think that everyone is a responder, it’s just a matter of when they respond?
So the standard answer is six weeks, thirty sessions. If they’ve achieved a certain level of symptom reduction, then they’re a responder. If they haven’t, then they’re not.
But there are two things that make it a little bit more interesting than that. After six weeks, a certain number of people have a partial response. They’ve noticed that it keeps getting better so they do another six weeks and it keeps improving. So there are some patients that continue to do TMS and we have a way to pay for it that isn’t that expensive. We’ve had patients go a long time doing TMS and if they’re continuing to improve or they don’t feel as good when they stop, we do consider continuing.
There are some people who don’t respond for months and some people respond right away. That tells us they are responders. But if a person doesn’t feel anything, we’ll go ahead and do a week. If they still don’t feel anything after a week – nothing good, nothing bad – there’s evidence that the odds of getting better at that point are about twenty percent. If they don’t feel anything at the end of two weeks, the odds of getting better are only ten percent.
So should people who haven’t felt anything in the first two weeks continue with that treatment? The old answer was yes. The new answer is that perhaps it might be a good idea to look at the patient more carefully, to maybe do some brain imaging, especially if they’re left-handed or mixed dominance in terms of their handedness. Also, to consider doing an alternate site, alternate frequency or reassessing the diagnosis.
Do you find that gender and age was a factor in responding?
Young people tend to respond a little bit quicker and in a more robust fashion. Gender doesn’t matter that much. There’s a slight benefit for femaleness.